Role of relaxin in diastasis of the pubic symphysis peripartum.
Role of relaxin in diastasis of the pubic symphysis peripartum.
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DOI：
10.12998/wjcc.v9.i1.91
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发表时间：
2021-01-06
影响因子：
1.1
通讯作者：
Zheng ZC
中科院分区：
文献类型：
--
作者：
Wang Y;Li YQ;Tian MR;Wang N;Zheng ZC
耻骨联合分离可发生在围产期。松弛素（RLX）是一种主要由黄体分泌的激素，可以介导妊娠期间血液动力学的变化以及松弛骨盆韧带。然而，目前尚不清楚RLX是否与围产期耻骨联合分离有关，以及这种联系是否受其他因素的影响。研究RLX与围产期耻骨联合分离之间的关系，并评估可能影响这种关系的其他因素。我们在2019年4月至2020年1月期间对孕妇进行了一项横断面研究。记录基线人口统计学特征，包括胎龄、体重、新生儿体重、分娩方式以及第一和第二产程持续时间。妊娠期以临床症状作为筛查指标，对耻骨联合及腹股沟疼痛患者行彩色多普勒超声检查，判断是否存在耻骨联合分离。采用酶联免疫吸附试验测定产后1 d血清RLX浓度，并根据产后X线检查诊断耻骨联合分离。我们采用独立样本t检验分析血清RLX水平与围产期耻骨联合分离之间的相关性。采用多元回归分析评价RLX与围产期耻骨联合分离之间的关联是否受到其他因素的混淆，并评估RLX与耻骨联合分离严重程度之间的关联。我们使用Pearson相关分析来确定与RLX水平相关的因素以及耻骨联合分离程度与日常生活活动（ADL）和疼痛之间的相关性。共有54名妇女参加了这项研究，其中15名妇女表现出（观察组）和39名妇女没有表现出（对照组）围产期耻骨联合分离。两组之间在母亲年龄、胎龄、孕前体重、妊娠期间体重增加、分娩方式或第一或第二产程持续时间方面无统计学显著差异。然而，我们确实注意到观察组和对照组之间血清RLX浓度和新生儿体重存在统计学显著差异（分别为122.3 ± 0.7 µg/mL vs 170.4 ± 42.3 µg/mL，P < 0.05; 3676.000 ± 521.725 g vs 3379.487 ± 402.420 g，P < 0.05）。多因素回归分析显示，血清RLX水平（OR：1.022）和新生儿体重（OR：1.002）与围产期耻骨联合分离相关。耻骨联合分离程度与ADL呈负相关，与疼痛呈正相关。校正混杂因素后，血清RLX水平与耻骨联合分离的严重程度之间无统计学显著相关性。血清RLX水平和新生儿体重与围产期耻骨联合分离的发生有关，但与其严重程度无关。
Separation of the pubic symphysis can occur during the peripartum period. Relaxin (RLX) is a hormone primarily secreted by the corpus luteum that can mediate hemodynamic changes during pregnancy as well as loosen the pelvic ligaments. However, it is unknown whether RLX is associated with peripartum pubic symphysis separation and if the association is affected by other factors. To study the association between RLX and peripartum pubic symphysis separation and evaluate other factors that might affect this association. We performed a cross-sectional study of pregnant women between April 2019 and January 2020. Baseline demographic characteristics, including gestational age, weight, neonatal weight, delivery mode and duration of the first and second stages of labor, were recorded. The clinical symptoms were used as a screening index during pregnancy, and the patients with pubic symphysis and inguinal pain were examined by color Doppler ultrasonography to determine whether there was pubic symphysis separation. Serum RLX concentrations were evaluated 1 d after delivery using an enzyme-linked immunosorbent assay, and pubic symphysis separation was diagnosed based on postpartum X-ray examination. We used an independent-sample t test to analyze the association between serum RLX levels and peripartum pubic symphysis separation. Multivariate regression analysis was used to evaluate whether the association between RLX and peripartum pubic symphysis separation was confounded by other factors, and the association between RLX and the severity of pubic symphysis separation was also assessed. We used Pearson correlation analysis to determine the factors related to RLX levels as well as the correlation between the degree of pubic symphysis separation and activities of daily living (ADL) and pain. A total of 54 women were enrolled in the study, with 15 exhibiting (observational group) and 39 not exhibiting (control group) peripartum pubic symphysis separation. There were no statistically significant differences in terms of maternal age, gestational age, pre-pregnancy weight, weight gain during pregnancy, delivery modes, or duration of the first or second stages of labor between the 2 groups. We did, however, note a statistically significant difference in serum RLX concentrations and neonatal weight between the observational and control groups (122.3 ± 0.7 µg/mL vs 170.4 ± 42.3 µg/mL, P < 0.05; 3676.000 ± 521.725 g vs 3379.487 ± 402.420 g, P < 0.05, respectively). Multivariate regression analyses showed that serum RLX level [odds ratio (OR): 1.022) and neonatal weight (OR: 1.002) were associated with pubic symphysis separation peripartum. The degree of separation of the pubic symphysis was negatively correlated with ADL and positively correlated with pain. There was no statistically significant association between serum RLX levels and the severity of pubic symphysis separation after adjusting for confounding factors. Serum RLX levels and neonatal weight were associated with the occurrence, but not the severity, of peripartum pubic symphysis separation.
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